We at Promaestro post and track information on claim denials and rejections. We are well-equipped with effective denial management and collection management tools. We handle rejections and denials by collecting missing data, re-submitting revised electronic claims within the specified time-line.

At Promaestro, with medical billing software and a perfectly blended electronic claim submission process, practices can get paid faster from the insurance companies and other payers. This greatly reduces the hindrances and disruptions in the effective cash flow of the medical practice.

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Denials as Payment Discrepancies

Denials as Payment Discrepancies

Understanding your Denials

Denials as Payment Discrepancies

Effective Denial Management Services from Promaestro:

Promaestro, one of the prominent players in the medical billing market offers effective Denial Management for its clients. According to a research in the health care sector, nearly 20 to 30% of raised health care insurance claims are rejected or denied. As a result of such rejections and denials, health care organizations face heavy losses every year and this in the long run can affect the productivity and sustainability of the medical practice to a bad extent. A thorough and effective denial management process could wipe out such rejections and denial worries.

Key Differentiators handling Denials for our clients:

  • Reduced First pass denials by identifying and correcting root causes
  • Root causes of why denials are occuring
  • Improved follow-up processes for denied claims
  • Identified compliance risks
  • Measured error rates for manufacturing processes
  • Established framework for breakthrough process improvement
  • Utilizes a series of denied steps that can be continuously repeated until a process is maximized
  • Implement technology to eliminate manual processes and standardize
  • Trained those involved regarding standardized processes
  • Changed workflow and transition to paperless environment

Claims Processing Reports:

Once the electronic claims have been generated, the superior-quality Practice Management software at Promaestro authenticates the claims for any missed-out or inappropriate information. Also the claim is verified against payer-specific requirements. In case of any issue or error, you will receive the claims processing report identifying the weak points and list of rejections, those needs to be set on before passing on to the government and other payers. At this stage, the status of your claims will be altered to “rejected”. This initiates the process of reviewing the rejected claims and re-submitting the same.

Electronic Remittance Advice Reports:

Once the claims are passed on to the government and other payers, they are once again reviewed and adjudicated for payment. With Promaestro’s effective methodologies you could receive an electronic remittance advice report from the payer with the details on payments and denials.  At this stage, the status of your claims will be changed to "denied”. This might significantly help to identify the sources that lead to denial and take action with essential steps to fix the issues. 

Reasons for Rejection or Denial:

There are a plethora of reasons available for a claim rejection or denial. May be, the insurance coverage of the patient might not have covered certain medical services or the services rendered may not be considered medically compulsory. Promaestro assists medical practices in identifying the loop holes in submitting claims and patch up those areas for the expected output in terms of productivity and cash-flow.

Effective Denial Management:

Once the claims are categorized as rejected or denied they are automatically structured into a work-list. Promaestro offers an effective denial management solution in the form of rejection and denial messages. Every rejection or denial will carry its reason in the form of rejection or denial message. You can roll down to the affected claims to review, resolve and resubmit it. Once the claim has been resubmitted, it is removed from the worklist. Doesn’t this look simple, yet effective?

Root-Cause and Rectification:

Though identifying and resolving claims denials and rejections have become easy and attainable with Promaestro, we just don’t leave you half the way, we take the responsibility to identify the root-cause of the rejections. This greatly helps our clients to a more effective claims management in the future.

Denial Management Reports:

Your Denial management reports at Promaestro are categorized according to the rationale and the money value inclined in due course. This helps our clients to identify the habitually persistent denials and rejections and assign changes according to the reports in your work flow management. This could avoid repetition of errors that might lead to claims denials and rejections.

Contact us today and let us show you how we can reduce your denials & improve your collections, increase your bottom line and drive value and return.